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General NPI Number Information
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NPI Number | 1962689604
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Entity Type | Organization
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Legal Business Name | CVS
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Dates
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Enumeration Date | 01/24/2008
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Last Update Date | 01/24/2008
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Provider Practice Location Address
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Address Line | 682 ROUTE 25A
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City | EAST SETAUKET
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State | NY
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Zip | 11733-1238
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Country | US
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Telephone | 631-246-8735
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Fax |
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Provider Business Mailing Address
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Address Line | 682 ROUTE 25A
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City | EAST SETAUKET
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State | NY
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Zip | 11733-1238
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Country | US
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Telephone | 631-246-8735
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Fax |
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Authorized Official
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Title or Position | SUPERVISING PHARMACIST
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Name | MR. JEROME M WEXLER
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Credential |
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Telephone | 631-246-8735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 034318
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License Number State | NY
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